How to beat addiction

According to doctors as many as one in five Australians has a problem with substance use and and many of those people will develop an addiction.The annual cost to the community is estimated at $50 billion. That is more each year than the entire National Broadband Network is predicted to cost to build over 10 years.

The $50 billion includes not only the lost productivity and income of those with the problems, but the indirect costs to families of caring for affected people as well as the drain on the legal, health and policing systems.

Addiction is defined as compulsive seeking and using that has behavioural consequences. It is not about choice. Many people attempting to end an addiction suffer chronic relapses.

While the problem is evidently enormous, there is cause for optimism. Advances during the past 20 years in neuroscience - the study of the brain and nervous system - provide reason to believe the treatment of addiction might be poised for a breakthrough.

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One of the few pioneers in this country on the use of neuroscience in addiction treatment is today's guest in The Zone, Professor Jon Currie, who has just set up the National Centre for the Neurobiological Treatment of Addiction. The full transcript of our interview, as well as a short video statement by Currie, is at theage.com.au/opinion/the-zone.

''Addiction is a brain disorder, a brain disease. Addiction is about it not being a choice. Addiction is about compulsive use, or a compulsive behaviour, even knowing the negative health and social consequences. So the concept of 'just say no' does not really apply here.

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''It is this compulsion to do it even if you have been told and you know and can even enunciate the risks and problem.'' People can be addicted to alcohol, tobacco, illicit drugs, prescribed pain or sedative medication, and also to behaviours, including gambling and excessive food intake. Currie says Australia has focused on psychological and other counselling to support addicts, and been slow to the point of sclerotic in understanding, let alone embracing, medical treatments.

''We have a total failure in this country in the use of brain treatment. And that is usually pharmacological, medical treatment for supporting and treating patients with addiction.''

He says there is a wide range of existing medications that can be used in new ways to help control addicts' desires and offset the difficult side-effects of ending a behaviour or the use of a substance. There are, for example, medications to help restore chemical balances in the brain, to re-establish regular sleep patterns, to reduce or even block the intoxicating effects of alcohol and other drugs and to inhibit cravings.

''I don't like people suffering … I see this as a medical issue and if there aren't adequate medical treatments, then it is my job to make medical treatments available.''

The vast majority of addicts suffer, and want, often desperately, to end their addiction. Currie is keen to confront the common misconception that addicts are reprehensible. ''It is just so critical for everyone to realise that when there is a problem with addiction it is not because people are bad or just weak-willed and cannot say no or are giving in to their lusts and their needs.

''There is a tendency as soon as someone relapses to blame them as being weak or it's a moral failing or they just didn't try hard enough. So, there is a blame the patient, blame the victim mentality for not being strong enough to say no to drugs. But we don't say that if somebody relapses with arthritis or has a relapse with blood pressure problems or has a relapse with diabetes. This is part of a chronic disease model.''

Chronic disease requires long-term treatment. The brain pathways of addicts are altered; the interconnections in the brain are changed and can remain abnormal for months and even years beyond the end of the substance use or problematic behaviour. This is why many people relapse after short-term treatments.

''We face the situation at the moment where so much treatment is revolving-door. People go into relatively high-cost, intensive treatments - it may be residential rehabilitation or it may be the detoxification units or withdrawal units. They emerge from those a week or a month or six months later with very little change in brain function and often relapse.''

A fundamental component of addiction is genetic. There is a strong correlation between genetic predisposition and the approximately one in 10 substance users who becomes addicted, Currie says. This why he believes the offspring of addicts should be a particular focus of education programs.

Another core element in many addictions is mental health. The causality can run both ways; people can develop addictions by self-medicating conditions including depression and anxiety, and people's substance use can cause mental health problems.

''People with mental health issues and addiction issues are one part of a whole continuum. In some, the mental health issues are predominant. In others, the addiction issues are. But there is a very, very big group in the middle where they are concomitant and overlapping.''

Currie also stresses the majority of people who choose to use substances will not become addicted, but that should warning signs emerge, it is critical to get help early. ''If you can intervene early then, and intervene easily, painlessly and effectively, then you can prevent the progression.''

What are the signs your use is becoming a problem? ''The most important things are recognising that your use is starting to diverge from that, say, of your friends. The classic example is that you go out to a party with your friends and then you seek the next party and the next party and the next party each day of the week.

''In other words, the drug or the behaviour, particularly gambling for instance, becomes more and more and more consuming, more central to your lifestyle. Your ability to not do it becomes increasingly diminished, so you more and more feel you are compelled to do it. Early attempts just to quit don't work. All of these things should flag very early that this is getting beyond your ability to just stop.''

Currie set up his centre in hope - and in frustration. As director of the Department of Addiction Medicine at St Vincent's Hospital, he grew concerned at the lack of support within the public health system for the medical treatment of addiction. He believes Australia is lagging terribly behind the United States and Europe.

''(In Australia), the neurological world is relatively still involved in stroke, epilepsy and areas which are, if you like, conventional neurology. They do that very brilliantly. But the behavioural neurology, that field between the mind and the brain and how it affects behaviour, is not an area that we lead in terms of treatment or understanding.

''If you look at the websites of most of the major universities in the United States with medical centres, they will have neuroscience of addiction websites. In Australia it almost doesn't exist.'' But he is optimistic. Demand will lead supply, he says. He says patients, armed with some of the bountiful information on the internet, will ask for these treatments, which can be given by general practitioners as well as specialists. ''The need of the person with the problem will actually drive the demand for treatments, which they will see all over the world. It is a global village.''

Addiction medicine has finally been recognised as a specific medical specialty by the Commonwealth government and the Australian Medical Council. But in Australia there are fewer than 15 doctors actually training in this specialist field, Currie says. This is partly because the medical treatment of addiction is, in effect, only partly officially recognised - it is not reimbursed by Medicare as a specialty.

That seems strange, and perhaps destined for change; public policy tends to evolve when compelling evidence emerges. The evidence, Currie says, is that by using medical treatments alongside traditional methods, as many as seven in 10 addicts can remain abstinent.

Currie set up the centre in part to help patients and to train other doctors. But most of all, he is trying to demonstrate the lives of many Australians will be improved if the medical profession applies knowledge from the revolution in neuroscience.

''In the end, the best way to change policy is to create a shining light, to show that it will work, and then say to everyone, 'look, this is how we did it and you can take any aspect of this that you like, but know that these are the fundamentals by which it works'. We're creating, we hope, something which will become an exemplar for other people to model.''